TAN CHEN WU
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
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conferenceObject Brugada syndrome: value of electrophysiologic study in the risk stratification(2017) PAIXAO, G.; LAMES, C.; ROSA, X.; SACILOTTO, L.; DARRIEUX, F.; CHORK, M.; WU, T. C.; PISANI, C.; HACHUL, D.; SCANAVACCA, M.- Trombo Atrial Esquerdo e Contraste Espontaneo Denso no Uso de Anticoagulante Oral de Acao Direta em Fibrilacao Atrial: Visao de Centro Referenciado(2022) MARQUES, Thiago; DARRIEUX, Francisco; GOUVEA, Fabio; GARAMBONE, Leandro; LINDOSO, Ana Paula; LAGE, Joao; SACILOTTO, Luciana; COIMBRA, Ana Lucia; PINHEIRO, Martina; OLIVETTI, Natalia; LARA, Sissy; HARDY, Carina; ATHAYDE, Guilherme; HACHUL, Denise; PISANI, Cristiano; WU, Tan Chen; SCANAVACCA, MauricioBackground: In the treatment of atrial fibrillation (AF), the most frequently sustained arrhythmia, with catheter ablation (CA) or electrical cardioversion (ECV), the periprocedural period is one of the most critical phases. Currently, the use of new direct action oral anticoagulants (DOAC) is increasingly frequent; however, in the real world, there are still few data on studies on the thrombus incidence in the left atrium (TrLA) or dense spontaneous contrast (DSC) on transesophageal echocardiogram (TEE). Objective: To evaluate the prevalence of events and association with risk factors in patients using DOACs. Primary objective: to analyze the prevalence of thrombus in the LA by TEE in patients using DOAC undergoing ECV/CA. Second, evaluate the association of comorbidities with the presence of thrombi and DSC. Methods: Retrospective cohort, single-center study with patients followed at the Arrhythmia Outpatient Unit (InCor-HCFMUSP). Patients indicated for procedures and using DOACs were selected, and their clinical/echocardiographic data were analyzed. A significance level of 5% was considered. Results: 354 patients were included, a total of 400 procedures, from March 2012-March 2018. Thrombus in the LA was found in 11 patients (2.8%), associated with advanced age (p=0.007) and higher CHA2DS2-VASc (p<0.001) score. DSC in the LA before TEE was found in 29 patients (7.3%), with lower LVEF (p<0.038) and greater LA dimension (p<0.0001). Conclusion: The incidence of LA thrombus and DSC in patients using DOC in the context of AF ECV/CA, although small, is not negligible. Patients with higher CHA2DS2-VASc scores, especially older and with larger LA diameter, are more prone to these echocardiographic findings.
conferenceObject Atrial fibrillation as a cornerstone of laminopathy(2018) CALIL, Z. O.; PESSENTE, G. A.; SACILOTTO, L.; OLIVETTI, N. Q. S.; HACHUL, D. T.; WU, T. C.; GRUPPI, C. J.; CARVALHO, M. L. P.; ARANHA, A. F.; PEDROSA, A. A. A.; HARDY, C. A.; PISANI, C. F.; PEREIRA, A. C.; SCANAVACCA, M. I.; DARRIEUX, F. C. C.- Efficacy and safety of combined endocardial/epicardial catheter ablation for ventricular tachycardia in Chagas disease: A randomized controlled study(2020) PISANI, Cristiano F.; ROMERO, Jorge; LARA, Sissy; HARDY, Carina; CHOKR, Muhieddine; SACILOTTO, Luciana; WU, Tan Chen; DARRIEUX, Francisco; HACHUL, Denise; KALIL-FILHO, Roberto; BIASE, Luigi Di; SCANAVACCA, MauricioBACKGROUND Epicardial mapping and ablation are frequently necessary to eliminate ventricular tachycardia (VT) in patients with Chagas disease. Nonetheless, there are no randomized controlled trials demonstrating the role of this strategy. OBJECTIVE We conducted this randomized controlled trial to evaluate the efficacy and safety of combined epicardial ablation in patients with Chagas disease. METHODS We randomized patients with Chagas disease and VT in a 1:1 fashion to either the endocardial (endo) mapping and ablation group or the combined endocardial/epicardial (endo/epi) mapping and ablation group. The efficacy end points were measured by VT inducibility and all-ventricular arrhythmia recurrence. Safety was assessed by the rate of periprocedural complications. RESULTS Thirty patients were enrolled, and most were male. The median age was 67 (Q1: 58; Q3: 70) years in the endo group and 58 (Q1: 43; Q3: 66) years in the endo/epi group. The left ventricular ejection fraction was 33.0% +/- 9.5% and 35.2% +/- 11.5%, respectively P = .13. Acute success (non-reinducibility of clinical VT) was obtained in 13 patients (86%) in the endo/epi group and in 6 patients (40%) in the endo-only group (P = .021). There were 12 patients with VT recurrence (80%) in the endo-only group and 6 patients (40%) in the endo/epi group (P = .02) (by intention-to-treat analysis). Epicardial ablation was ultimately per formed in 9 patients (60%) in the endo-only group because of an absence of endocardial scar or maintenance of VT inducibility. There was no difference in complications between the groups. CONCLUSION Combining endo/epi VT catheter ablation in patients with Chagas disease significantly increases shortand long-term freedom from all-ventricular arrhythmias. Epicardial access did not increase periprocedural complication rates.
- Catheter Ablation of Focal Atrial Tachycardia with Early Activation Close to the His-Bundle from the Non Coronary Aortic Cusp(2021) CHOKR, Muhieddine; MOURA, Lucas G. de; SOUSA, Italo Bruno dos Santos; PISANI, Cristiano Faria; HARDY, Carina Abigail; MELO, Sissy Lara de; PONTE FILHO, Arnobio Dias da; COSTA, Ieda Prata; TAVORA, Ronaldo Vasconcelos; SACILOTTO, Luciana; WU, Tan Chen; DARRIEUX, Francisco Carlos da Costa; HACHUL, Denise Tessariol; AIELLO, Vera; SCANAVACCA, MauricioBackground: Atrial tachycardia (AT) ablation with earliest activation site close to the His-Bundle is a challenge due to the risk of complete AV block by its proximity to His-Purkinje system (HPS). An alternative to minimize this risk is to position the catheter on the non-coronary cusp (NCC), which is anatomically contiguous to the para-Hisian region. Objectives: The aim of this study was to perform a literature review and evaluate the electrophysiological characteristics, safety, and success rate of catheter-based radiofrequency (RF) delivery in the NCC for the treatment of para-Hisian AT in a case series. Methods: This study performed a retrospective evaluation of ten patients (Age: 36 +/- 10 y-o) who had been referred for SVT ablation and presented a diagnosis of para-Hisian focal AT confirmed by classical electrophysiological maneuvers. For statistical analysis, a p-value of <0.05 was considered statistically significant. Results: The earliest atrial activation at the His position was 28 +/- 12ms from the P wave and at the NCC was 3 +/- 2ms earlier than His position, without evidence of His potential in all patients. RF was applied on the NCC (4-mm-tip catheter; 30W, 55 degrees C), and the tachycardia was interrupted in 5 +/- 3s with no increase in the PR interval or evidence of junctional rhythm. Electrophysiological tests did not reinduce tachycardia in 9/10 of patients. There were no complications in all procedures. During the 30 +/- 12 months follow-up, no patient presented tachycardia recurrence. Conclusion: The percutaneous treatment of para-Hisian AT through the NCC is an effective and safe strategy, which represents an interesting option for the treatment of this complex arrhythmia.
- QT Interval Control to Prevent Torsades de Pointes during Use of Hydroxychloroquine and/or Azithromycin in Patients with COVID-19(2020) WU, Tan Chen; SACILOTTO, Luciana; DARRIEUX, Francisco Carlos da Costa; PISANI, Cristiano Faria; MELO, Sissy Lara de; HACHUL, Denise Tessariol; SCANAVACCA, Mauricio
- Peculiar Aspects of Patients with Inherited Arrhythmias during the COVID-19 Pandemic(2021) SACILOTTO, Luciana; OLIVETTI, Natalia Quintella Sangiorgi; PISANI, Cristiano Faria; WU, Tan Chen; HAJJAR, Ludhmila Abrahao; MELO, Sissy Lara de; BUENO, Savia Christina Pereira; RIVAROLA, Esteban Wisnivesky Rocca; CHOKR, Muhieddine Omar; HARDY, Carina Abigail; HACHUL, Denise Tessariol; DARRIEUX, Francisco Carlos da Costa; SCANAVACCA, Mauricio IbrahimSince December 2019 we have observed the rapid advance of the severe acute respiratory syndrome caused by the new coronavirus (SARS-CoV-2). The impact of the clinical course of a respiratory infection is little known in patients with hereditary arrhythmias, due to the low prevalence of these diseases. Patients who present with infectious conditions may exacerbate hidden or well-controlled primary arrhythmias, due to several factors, such as fever, electrolyte disturbances, drug interactions, adrenergic stress and, eventually, the septic patient's own myocardial damage. The aim of this review is to highlight the main challenges we may encounter during the Covid 19 pandemic, specifically in patients with hereditary arrhythmias, with emphasis on the congenital long QT syndrome (LQTS), Brugada syndrome (SBr), ventricular tachycardia polymorphic catecholaminergic (CPVT) and arrhythmogenic right ventricular cardiomyopathy. Since December 2019 we have observed the rapid advance of the severe acute respiratory syndrome caused by the new coronavirus (SARS-CoV-2), the first cases of which arose in Wuhan, China, subsequently arriving in Brazil. Retrospective studies have shown that old age was an independent predictor of mortality by COVID-19. Other risk factors impacting mortality were systemic arterial hypertension, chronic pulmonary obstructive disease, immunosuppression, type-2 diabetes mellitus, obesity, and severe cardiopathy (heart failure, coronary disease, or cardiomyopathies).1,2 Overall, complications due to arrhythmias in patients with pneumonia, particularly atrial fibrillation, are relatively common.3,4 Cardiac arrest occurs in about 3% of hospitalized patients;5 however, less than 20% of cardiac rhythms of in-hospital events are reported as being electrically reversible to sinus rhythm (by cardioversion or defibrillation), i.e., ventricular tachycardia/fibrillation (VT/VF).6 In such patients, the primary arrhythmogenic mechanism is myocardial injury due to ischemia or inflammation.
- Initial experience on cardiac magnetic resonance-aided VT ablation in South America(2023) PISANI, Cristiano F.; ALEXANDRE, Felipe Kalil; KULCHETSCKI, Rodrigo; MAYRINK, Marina; WU, Tan Chen; CHOKR, Muhieddine; HARDY, Carina; MELO, Sissy Lara; ROCHITTE, Carlos; NOMURA, Cesar; SCANAVACCA, MauricioBackground: Cardiac magnetic resonance (CMR) allowed to precisely identify the substrate in scar-related ventricular tachycardia (VT). New software has been developed to define the 3D scar and corridors to help VT ablation by integrating the scar and electroanatomical mapping (EAM). The objective of this study is to evaluate the results of VT ablation aided by the integration of EAM and CMR software processed scar.Methods: We selected patients that underwent VT ablation with the integration of EAM and CMR processed using ADAS software and imported to the CARTO system using VTK file format.Results: From 2019 to 2021, eight patients (mean age 63 +/- 4.4, 62.5% male; EF 47 +/- 12%) underwent CMR-aided VT ablation. Mean procedural time was 281 +/- 77 min. There was of 9 +/- 4.4 epicardial and 7.9 +/- 4.3 endocardial bulls eye segments with at least 2 g of border zone or core scar. In a median follow-up time of 532 days (Q1: 284, Q3: 688), three patients (37.5%) presented VT recurrence, all three underwent a second procedure, with no VT recurrence on the follow-up. No patient died in the follow-up.Conclusion: CMR aided is ablation is feasible and effective in patients with scar related VT.
- Approaches to the Diagnosis and Management of Atrial-Esophageal Fistula After Catheter Ablation for Atrial Arrhythmias(2019) WU, Tan Chen; PISANI, Cristiano; SCANAVACCA, Mauricio I.Purpose of ReviewCatheter ablation has become a cornerstone of therapy in the management of patients with atrial fibrillation (AF). Thermal energy generated in the left atrium (LA) during ablation has the potential to damage adjacent structures. The most feared and rare complication in these ablations is atrial-esophageal fistula (AEF) result from the thermal injury to the esophagus due to the proximity to the LA, with potential catastrophic outcome. This review focuses on the diagnosis and management of AEF after catheter ablation for AF, including preventive measures to avoid esophageal lesions.Recent FindingsSymptoms of AEF are often vague and nonspecific, sometimes asymptomatic until they present with fistula or perforation, making the diagnosis somewhat challenging. The esophagogastroduodenoscopy is the gold standard for early detection of esophageal lesions related to AF ablation. Chest CT with oral and intravenous contrast is preferred when there is suspicion of perforation. The use of an esophageal temperature probe during ablation to monitoring esophageal temperature, associated with mechanical displacement of the esophagus, may be feasible to prevent thermal esophageal lesions and enabling adequate energy delivery to the posterior wall of the LA. Prophylactic use of proton pump inhibitors after AF ablation is accepted to be effective and justified as preventive treatment.SummaryAEF is an unpredictable complication. Be aware of these complications in the follow-up of patients after AF ablation can lead to the early recognition to start treatment, including surgical repair, as soon as possible to prevent the fatal outcome.
- Sinus Node Artery Occlusion During Cardiac Denervation Procedures(2022) SCANAVACCA, M.; RIVAROLA, E. W. R.; TORRES, R. V. A.; HARDY, C.; WU, T. C.; DARRIEUX, F.; PISANI, C.; HACHUL, D.Cardioneural ablation is a novel treatment for functional bradycardia. However, the risk of acute complications is still unknown. The aim of this case report is to describe acute occlusion of the sinus node artery after cardiac denervation procedures in 2 patients and to encourage measures to prevent it, such as evaluating the aortic angulation in older patients before the procedure and by monitoring signs of sinus failure during ablation in patients with electroanatomical maps showing a constricted aspect of the right atrium. (Level of Difficulty: Advanced.) © 2022 The Authors